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What We See In Others.
We can all of us do something to practise preventive medicine if we understand
the reactions of the people around us. In two recent articles1 on functional
disease2 we are told to notice how a person describes the symptoms. Now and
again there comes the dramatic pause where no pause should be; the exaggerated
description such as the violent, excrutiating, agonising, terrible pain, when it is
clear there is no pain at all; the woman who says her husband is the most
wonderful man in the world is sometimes trying to conceal her disappointment
in him; the person who discusses her symptoms by reference to a list in her
diary has obviously been preoccupied with herself and is almost always neurotic.
During emotional disturbances the pulse rate is raised; blood pressure
may rise to quite abnormal heights and fluctuate widely. Continued sighing
is a sign significant of anxiety neurosis or great fatigue. Excessive emotionalism
is often shown by flushing and blushing or excessive perspiration; often there
is loss of hair due to alopecia; the pupils are often dilated, the eyelids flutter,
the mouth quivers and twiches and there is a tremor in the voice. The patient
suffers frequently from headaches described with great exactness as occurring
in many parts of the head in different varieties. She may hear weird noises,
or have choking sensations in the throat, or have various ill-defined pains.
However, we doctors must make allowances; a clinical interview can be
quite frightening to some people. I once saw a strong healthy man faint when
waiting for a simple subcutaneous injection. I have seen women in the clinics
bring in long lists of written questions, mainly about themselves, when primarily
the visit was intended for the baby. Some are genuinely seeking advice and not
all are hypochondriacs, but even if they are, they require help to establish their
relationship with the environment again, for the hypochondriac is seeking
sympathy in order to gain favour and be in good standing with those around
her; because this is the essence of all behaviour, namely to so conduct yourself
as to live in the love and respect of those around you and so gain security and
freedom from fear.
1 Lonshin, L. L. 1956. Postgraduate Medicine, 19, 526.
2 Matthews, H. A. 1956. Postgraduate Medicine, 20, 53.
LITTLE STROKES
A little while ago I noticed a sudden change in the personality of an elderly
woman whom I knew well. From being a kindly likeable person, considerate
in her feelings for those around her and generous even to a fault, she suddenly
changed to an ungracious old woman. She appeared to have difficulty in distinguishing
even the members of her own family and had suddenly completely
forgotten their kindness and love for her over all the years of their lives.
Looking back on this incident I feel sure she had had a little stroke which
had been unrecognised. This is usually the result of clotting of the blood in a
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